Burden of infection and hospitalization from respiratory syncytial virus-associated acute lower respiratory tract infections in Chinese children: Modeling of national, regional, and provincial estimates.

BACKGROUND

Respiratory syncytial virus (RSV) is a major cause of acute lower respiratory tract infections (ALRIs) in children. To guide policymaking on controlling RSV-associated ALRIs (RSV-ALRIs) in China, we estimated the national, regional, and provincial burdens of RSV-ALRIs and associated hospitalizations for children under 5 years old.

METHODS

We systematically identified publications about RSV-ALRIs in China with epidemiological data before 2020. We compared seasonality data from this period with data during the COVID-19 epidemic. We built a dataset to assess RSV-ALRI burden by age and region, using a generalized linear mixed-effects model and a conceptual proportionality framework to assess hospitalization rates. A risk factor-based model were used to estimate regional and provincial RSV-ALRI incidence.

FINDINGS: Children aged 0 to 12 months had the highest risk of RSV-ALRI and associated hospitalization. Provincial variations existed, with some southern provinces exhibiting higher incidence and some western provinces higher hospitalization rates. The COVID-19 epidemic shifted RSV hospitalization peaks to early autumn (Guangdong, Shanghai), whereas Hubei and Shandong demonstrated delayed peak onset compared with the pre-pandemic period.

INTERPRETATION: Our study of the burden RSV-ALRIs in China identified obvious heterogeneity by age and region. These findings highlight the need for targeted RSV vaccination strategies and resource allocation prioritizing high-risk groups and areas.

FUNDING: This work was supported by the Shanghai Municipal Science and Technology Major Project (Grant No. ZD2021CY001), the National Natural Science Foundation of China (Grant No. 82073612), and Shanghai New Three-year Action Plan for Public Health (GWVI-1, GWVI-11.1-03 and GWVI-11.1-01).